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Anticoagulation Therapy After Transcatheter Aortic Valve Replacement.

Tarun Chakravarty1, Hasan Jilaihawi2, Angelo de la Rosa3

  • 1Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA. Tarun.Chakravarty@cshs.org.

Current Cardiology Reports
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PubMed
Summary

Subclinical leaflet thrombosis after transcatheter aortic valve replacement (TAVR) is common but resolves with anticoagulation. Routine anticoagulation post-TAVR is not recommended due to increased risks, unless clinically indicated.

Keywords:
AnticoagulationBioprosthetic valve thrombosisHALTHypoattenuated leaflet thickeningSubclinical leaflet thrombosisValve thrombosis

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Thrombosis Research

Background:

  • Subclinical leaflet thrombosis (SLT) is a recognized complication in both transcatheter and surgical bioprosthetic aortic valves.
  • SLT is dynamic, less prevalent in patients on anticoagulation, and resolves upon its initiation.

Purpose of the Study:

  • To review the prevalence, natural history, and impact of SLT.
  • To evaluate the role of anticoagulation following transcatheter aortic valve replacement (TAVR).

Main Methods:

  • Review of existing literature on subclinical leaflet thrombosis and anticoagulation post-TAVR.
  • Analysis of data regarding valve hemodynamics, clinical outcomes, and valve durability.

Main Results:

  • Anticoagulation reduces the prevalence of SLT and leads to its resolution.
  • Routine anticoagulation after TAVR in high-risk patients is linked to increased mortality and thromboembolic events.
  • No benefit of initiating anticoagulation solely for SLT prevention in the absence of other indications.

Conclusions:

  • Anticoagulation is not routinely recommended after TAVR for SLT prevention in patients without other clinical indications.
  • Anticoagulation should be initiated or continued in patients with established indications like atrial fibrillation or valve thrombosis events.
  • Management decisions regarding anticoagulation post-TAVR should be individualized based on patient-specific risk factors and indications.